뇌동맥류수술시기와방법에따른 Shunt 수술의빈도 : 뇌동맥류파열 514 예분석 *

Transcription

1 KISEP Clinical Research J Korean Neurosurg Soc , 1999 뇌동맥류수술시기와방법에따른 Shunt 수술의빈도 : 뇌동맥류파열 514 예분석 * 공민호 신용삼 허승곤 김동익 ** 이규창 = Abstract = Frequency of Shunt Surgery according to the Timing and Method of Aneurysm Surgery Analysis in 514 Cases with Ruptured Cerebral Aneurysms Min Ho Kong, M.D., Yong Sam Shin, M.D., Seung Kon Huh, M.D., Dong Ik Kim, M.D., ** Kyu Chang Lee, M.D. Department of Neurosurgery and Diagnostic Radiology, ** Brain Research Institute, Yonsei University College of Medicine, Seoul, Korea KEY WORDS 서 론 486 J Korean Neurosurg SocVolume 28April, 1999

2 공민호 신용삼 허승곤 김동익 이규창 1. 대상 연구대상및방법 2. 뇌동맥류수술 3. 자료분석 결 1. 수두증환자의연령분포 2. 파열뇌동맥류위치에따른수두증의발생율 Table 1. Age distribution of the patients with hydrocephalus 과 Ageyears Normal Hydrocephalus % in row % in row Table 2. Location of aneurysm and incidence of hydrocephalus Site of aneurysms Normal Hydrocephalus % in row % in row Anterior cerebral artery Internal carotid artery Middle cerebral artery Vertebrobasilar arteries J Korean Neurosurg SocVolume 28April,

3 뇌동맥류수술시기와방법에따른 Shunt 수술의빈도 : 뇌동맥류파열 514 예분석 3. Hunt & Hess grade에따른수두증의발생율 4. Fisher group에따른수두증의발생율 5. 뇌실외배액술과션트수술과의관계 Table 3. Hunt and Hess grade and development of hydrocephalus Hunt and hess grade Hydrocephalus Normal % in row % in row I II III IV V Table 4. Fisher group and development of hydrocephalus Fisher group Normal Hydrocephalus % in row % in row 수술시기에따른수두증의발생율 7. 요추천자배액술, 뇌조배액술, 종판및 Liliequist membrane의개방과수두증의발생율 8. 대조군 ( ) 과의비교 Table 5. The need for shunt operation following extraventricular drainage Extraventricular of shunt operation% in row drainage Need No need Yes No Table 6. Timing of aneurysm surgery and development of hydrocephalus Day after SAH* Normal Hydrocephalus % in row % in row ** *SAHsubarachnoid hemorrhage **p J Korean Neurosurg SocVolume 28April, 1999

4 공민호 신용삼 허승곤 김동익 이규창 Table 7. Lumbar and/or cisternal drainage of cerebrospinal fluid, and opening of the lamina terminalis and/or Liliequist membrane in the Fisher group 3 and 4 Procedure Normal Hydrocephalus% in row % in row No procedure Procedure Lumbar drainageld * 71 LD and cisternal drainage ** 30 Opening of the LT*** Opening of the LT LM*** *p0.005 **p0.001 ***LTlamina terminalis, LM Liliequist membrane Table 8. Characteristics of two groups Characteristics casesruptured/clipping surgery % Hunt Hess grade I II III IV V * Fisher group * * * Timing of aneurysm surgerydays after SAH Early Intermediate * Delayed * Combined procedure Combined procedure * Lumbar drainage Cisternal drainage 33 Opening of lamina terminalis Opening of Liliequist membrane 10 6 No combined procedure * *p0.005 Table 9. Incidence of the hydrocephalus and shunt operation* compared to the historical control group % of total Hydrocephalus ** No ventricular dilatation *Ventriculoperitoneal shunt or lumboperitoneal shunt **p0.005 J Korean Neurosurg SocVolume 28April,

5 뇌동맥류수술시기와방법에따른 Shunt 수술의빈도 : 뇌동맥류파열 514 예분석 고찰 조기수술 2. 혈성뇌척수액의배출 J Korean Neurosurg SocVolume 28April, 1999

6 공민호 신용삼 허승곤 김동익 이규창 3. 급성수두증환자에대한뇌실외배액술 결 론 References 1) Bagley C JrBlood in cerebrospinal fluid. Resultant functional and organic alterations in the central nervous system. A. Experimental data. B. Clinical data. Arch Surg , ) Black PMcLHydrocephalus and vasospasm after subarachnoid hemorrhage from ruptured intracranial aneurysms. Neurosurgery , ) Black PMcL, Tzouras A, Foley LCerebrospinal fluid dynamics and hydrocephalus after experimental subarachnoid hemorrhage. Neurosurgery , ) Foltz ELRecognition and treatment of hydrocephalus following spontaneous subarachnoid hemorrhage. Discussion J Neurosurg , ) Foltz EL, Ward AA JrCommunicating hydrocephalus from subarachnoid bleeding. J Neurosurg , ) Hyun MH, Kim KM, Bak KH, et alclinical analysis of subarachnoid hemorrhage with intraventricular hemorrhage due to aneurysmal rupture. J Korean Neurosurg , ) Jeong GH, Choi JY, Park SH, et altreatment of hydrocephalus following the operation of ruptured intracranial aneurysms. J Korean Neurosurg , ) Kassell NF, Torner JC, Haley EC Jr, et althe international cooperative study on the timing of aneurysm surgery. Part 1. Overall management results. J Neurosurg , ) Kassell NF, Torner JC, Jane J, et althe international cooperative study on the timing of aneurysm surgery. Part 2. Surgical results. J Neurosurg , ) Kasuya H, Shimizu T, Kagawa MThe effect of continuous drainage of cerebrospinal fluid in patients with subarachnoid hemorrhagea retrospective analysis of 108 patients. Neurosurgery , ) Kibler RF, Couch RSC, Crompton MRHydrocephalus in the adult following spontaneous subarachnoid hemorrhage. Brain , ) Kim DS, Huh SK, Choi JU, et alhydrocephalus in ruptured intracranial aneurysms. J Korean Neurosurg , ) Kolluri VRS, Sengupta RPSymptomatic hydrocephalus following aneurysmal subarachnoid hemorrhage. Surg Neurol , ) Kusske JA, Turner PT, Ojemann GA, et alventriculostomy J Korean Neurosurg SocVolume 28April,

7 뇌동맥류수술시기와방법에따른 Shunt 수술의빈도 : 뇌동맥류파열 514 예분석 for the treatment of acute hydrocephalus following subarachnoid hemorrhage. J Neurosurg , ) Laurence KMThe pathology of hydrocephalus. Ann Roy Coll Surg Engl , ) Lee JW, Kim TS, Lim YJ, et alsymptomatic hydrocephalus after subarachnoid hemorrhage. J Korean Neurosurg , ) Ljunggren B, Brandt L, Kagstrm EResults of early operations for ruptured aneurysms. J Neurosurg , ) Milhorat THAcute hydrocephalus after aneurysmal subarachnoid hemorrhage. Neurosurgery , ) Samson DS, Hodosh RM, Reid WR, et alrisk of intracranial aneurysm surgery in the good grade patientearly versus late operation. Neurosurgery , ) Schiefer W, Kanzner E Klinische-Echoenoephalographie. Berlin Springer, ) Shulman K, Martin BF, Popoff N, et alrecognition and treatment of hydrocephalus following spontaneous subarachnoid hemorrhage. J Neurosurg , ) Vale FL, Bradley EL, Fisher WS IIIThe relationship of subarachnoid hemorrhage and the need for postoperative shunting. J Neurosurg , ) van Gijn J, Hijdra A, Wijdicks EFM, et alacute hydrocephalus after aneurysmal subarachnoid hemorrhage. J Neurosurg , ) Vassilouthis J, Richardson AEVentricular dilatation and communicating hydrocephalus following spontaneous subarachnoid hemorrhage. J Neursurg , ) Yasargil MG, Yonekawa Y, Zumstein B, et alhydrocephalus following spontaneous subarachnoid hemorrhage. Clinical features and treatment. J Neurosurg , J Korean Neurosurg SocVolume 28April, 1999